Co-author: Aine Markham, Health Policy Analyst, Advisor, MSF
With all the hype and fanfare on the advances in global health (erroneously or not) attributed to the Millennium Development Goals era and the positive spin placed on the new, highly ambitious, all-encompassing development agenda known as the Sustainable Development Goals (SDGs), people could be forgiven for thinking that for the most part, the world's health problems are solved.
But sadly this is not the case.
MSF can vouch for the lack of adequate health services in, at present, the 63 countries where it has teams working. Among these populations and others like them, there is probably little knowledge and unlikely to be any celebration when the SDGs are adopted by a special UN summit in NYC at the end of September.
"The emphasis on countries doing more for themselves and aid being increasingly used as a 'catalyst' to drive economic growth does not bode well for global health."
In the past 15 years the world saw real change and significant health gains in many countries, particularly for people living with HIV/AIDS, tuberculosis and malaria, resulting from well-targeted, people-centred, innovative and properly funded healthcare programmes. It also saw the greatest number of displaced people since World War II. In some cases, populations that once had access to healthcare no longer do. Healthcare structures and staff have, in some countries, have become targets of warfare, and people have been deprived of the most basic services.
The world has also witnessed serious threats to global health such as the progressive increase in antibiotic resistance which risks undoing many of the advances seen in population health today. Or the explosion of ebola in West Africa, to which the world had no treatment response, resulting in thousands of deaths and an epidemic that is still on-going. But there are also populations that due to government inability, inefficiency or just plain exclusion, have failed to gain access to adequate healthcare or medicines and whose needs remain critical and immediate.
The SDGs, which will be rolled out in 2016 over the following 15 years worldwide -- at least on paper -- do include one health goal and a number of targets linked to key diseases, nutrition and other social determinants of health. However with so many other priorities within the SDGs (climate change, peace and security, water, and many more), something has to give. Recent trends and postulating by key international donors indicate a push back to the paradigm of the 1980s, when the major concern about health was associated with "how much it cost" and not the cost of suffering to people with little if any access to quality health services, existing medicines or diagnostics.
The world remains very much a mixture of those that have and those that have not and a new development agenda, regardless of how well intentioned, will do little to change this if it is not translated into concrete action with sufficient funding.
Recent trends in international aid come in stark contradiction to intentions, with a progressive decrease in concessional funding to healthcare. The emphasis on countries doing more for themselves and aid being increasingly used as a "catalyst" to drive economic growth does not bode well for global health. Fragile health gains cannot be maintained and ambitious targets cannot be reached if health does not drive policy.
"More research and development, especially on behalf of developing countries, is required and should be aimed at supporting healthy populations, not only healthy profits."
Countries such as the Democratic Republic of Congo (DRC), with overwhelming needs in many social sectors, but with less than 17% of people with HIV receiving treatment according to UNAIDS (report in French), should not be obliged to make impossible choices, nor for their population to pay fees to seek care that they often can't afford. In the capital Kinshasa, people have to go through such a long, painful and costly search for HIV diagnosis and care that when they present at the hospital, they are at a very advanced stage in the disease. One in four patients hospitalised at the MSF-supported hospital Kabinda dies, paying the price for not having access to timely antiretroviral treatment. This is unacceptable, and throws us back 20 years in time.
People in countries moving up the income ladder do not automatically gain access to functioning health systems once classified as middle income economies. For instance these countries will be home to 70% of people living with HIV by 2020, face increasing threats to their ability to access affordable generic medicines.
People marginalised due to conflict and instability or social exclusion exist today and will still exist tomorrow. Regardless of where they live or their economic situation, people deserve access to existing medicines and treatments, as well as to newer ones. More research and development, especially on behalf of developing countries, is required and should be aimed at supporting healthy populations, not only healthy profits. MSF doctors were powerless with no new tools to treat the more than 10,000 people admitted to MSF Ebola Treatment Centres across three West African countries, four decades after the first outbreak and over a year after the current outbreak began. Doctors, while relieved to have new drugs to treat drug-resistant tuberculosis (DR-TB), realise that these new combinations will still not provide patients with the outcomes they deserve, and in many countries the drugs remain unaffordable or unavailable. The basic must-have package of vaccines for immunising children is now 68 times more expensive than it was in 2001 and at the lowest available global prices it is still not accessible to many countries, or to humanitarian organisations such as MSF.
If the SDG slogan to "Leave no one behind" and goal to achieve Universal Health Coverage are to be more than wishful thinking, this new development agenda needs to bring with it immediate actions and a shift in current approaches to ensure that health remains a priority and is not reduced to a commodity.